Table of Contents

CD 1.1 Adults with respiritory problems - level 2

Care for patients with airway & respiritory system problems

CD1 1.1.1 (L2) Anatomy & Physiology

Read sections 22.1 to 22.3 of this online textbook for a brief review of the respiritory system (approx 40 minutes). (College, 2013)

Make a few notes as you watch this eight minute video by (Faigl, 2020). You must familiarise yourself with the important lung volumes and capacities (approx 8 minutes). A brief mcq follows shortly...

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CD! 1.1.2 (L) Assessment

Watch this nine minute video by (Potter, 2019) (approx 9 minutes).

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If you wish to explore this in more depth then feel free to check out the companion site which provides more detail.

Respiritory system noises

Factors that are used to assess noises generated in the respiratory system are:

• continuous/discontinuous
• frequency/pitch
• inspiratory/expiratory
• quality (musical/crackling/whistling, etc)
• associated conditions (asthma/copd/fibrosis, etc)

Wheezes are caused by partial obstruction of the airways by secretions or bronchoconstriction.

Crackles are caused by interstitial fluid or plasma that has leaked into the airways.

Wheeze (high pitch)

High Pitched, Polyphonic (Sibilant) Wheeze.

Heard mainly in expiration but may be present during inspiration. Sounds like a high-pitched musical instrument with more than one type of sound quality, e.g., asthma.

Wheeze (low pitch) aka Rhonchi

Low-pitched, Monophonic Wheeze (Sonorous) Wheeze. Caused by air moving through secretions.

Auscultated mainly in expiration but may be present at anytime. Sounds like a low-pitched whistling tune or whine with one type of sound quality. Low-pitched because it occurs in the upper airways. May be heard in patients with COPD or pneumonia etc. Rhonchi is a deprecated clinical term.

Coarse Crackles aka Rales (low pitch rales)

Heard mainly during inspiration but can extend into expiration as well. Low-pitched, wet bubbling sound. May be heard in patient with fluid overload, pneumonia etc. Rales is a deprecated clinical term.

Stridor

Heard during inspiration. Harsh, high-pitched whistling or gasping sound. Epiglottitis, or severe croup, but possibly anyone with upper airway obstruction.

Pleural rub

Sounds like walking on fresh snow, or a loud grating sound, generally throughout both phases of respiration. Caused by inflamed pleurae rubbing on one another. NB chest drains (drain pleural space) cause similar sounds.

Fine Crackles aka Rales (high pitch rales)

High-pitched, interrupted, non-musical, crackling sound similar to crackling fireworks, or velcro heard during inspiration.

Often occurring due to opening of small airway that have not been cleared by coughing.

Fine crackles heard throughout inspiration suggest pathology in the alveoli. However crackles heard just at the very beginning of breathing-in can sometimes be heard in copd.

• Fine crackles - pulmonary fibrosis, interstitial pneumonia.

• Medium crackles - pulmonary oedema, adult respiritory distress syndrom (ARDS).

• Coarse crackles - indicate pools of retained secretions in conditions such as bronchiectasis.

May be heard in patients with edema in the lungs or ARDS (acute respiratory distress syndrome).

Physiological concepts to understand...

It will help you to internalise these volumes and capacities if you actually adjust your breathing to match what you are reading about in this section. For instance, when you read the line about total Lung Capacity then breathe in as much as you can. Then breathe it all out when you read the next line about Vital capacity...

Total Lung capacity (TLC) is the amount of gas in the lungs after a maximal inspiration.

Vital capacity (VC) is the amount of gas exhaled after a maximal inpiration followed by a maximal expiration.

The Residual Volume (RV) is the amount of gas remaining in the lungs after a maximal expiration (20% of TLC).

• VC + RV = TLC

Tidal Volume (TV) is the amount of gas moved during normal breathing (7-8% of TLC).

The Inspiratory Reserve Volume (IRV) is the amount of gas an individual can inhale above a tidal inspiration (60% of TLC).

The Expiratory Reserve Volume is the amount of gas that can be exhaled beyond a tidal expiration (20% of TLC).

• TV + IRV + ERV = TLC

Functional Residual Capacity (FRC) is the amount of gas remaining in the lungs after a tidal expiration (40% of TLC).

The Inspiratory Capacity (IC) is the total amount of gas that can be inhaled starting at a tidal expiration (60% TLC).

• IC = TV + IRV

The Functional Residual Capacity (FRC) is the volume of air present in the lungs at the end of passive expiration.

• FRC = ERV + RV

Forced expiratory volume (FEV) measures the volume of air exhaled with maximal forced effort from a maximal inspiration. The amount of air exhaled may be measured during the first (FEV1), second (FEV2), and/or third seconds (FEV3) of the forced breath.

Forced vital capacity (FVC) is the total amount of air exhaled during the FEV test.

Relationship between VC & FVC: VC is similar to the FVC, but the manoeuvre is not forced and it is performed in a relaxed manner, except near the end-inspiration and end-expiration.

spirometry is a ventilatory pulmonary function test that measures FEV1 in litres, FVC in litres, VC in litres and calculates FEV1/VCas a perrcentage.

Care to check your understanding using this interactive QUIZ? Your score will not be recorded, or viewed by anyone else. This quiz widget may load slowly sometimes, especially the first time.

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